Defusing the Debate: 'After Tiller' Profiles Third-Trimester Abortion Providers

When we think of hazardous professions, that of an OB/GYN does not necessarily come to mind. But when such doctors perform late abortions, they perilously become the targets of an aggressive faction of the anti-abortion movement. In May 2009, Dr. George Tiller was gunned down while attending Sunday services at his church in Wichita, Kansas. Shockingly, he was the eighth such fatality since the passing of Roe v. Wade in 1973. With his death, there are now only four doctors in the country who openly provide third-trimester abortions.

These doctors are vilified, hunted, harassed and persecuted constantly by an increasingly sectarian pro-life movement. But to their patients, they are caring, compassionate listeners who assist them at a very vulnerable stage in their life. After Tiller, a documentary by Martha Shane and Lana Wilson, delves into the lives of these four seemingly "controversial" doctors, who were close friends of Tiller, as they face numerous obstacles—from increasingly restrictive legislation affecting their medical practice, to personal and moral dilemmas.

Documentary spoke to Wilson and Shane, on the phone from New York. Wilson explained the origin of the film: "The idea came from watching the news and thinking about how Dr. Tiller was killed in a church. Since many of the anti-abortion people are Christians, isn't it surprising that their number one villain is a Christian himself, who had been going to the same church with his family for over 25 years? And [I also thought], Who would do this kind of work? What are their lives like? What is it like to have all this pressure on you every day, going to your job, driving in an armored car? Dr. Tiller was shot in the 1990s, and went back to work the next day. What kind of personality would it take to do that?"

From the outset, the filmmakers were clear that they did not have a political agenda, but rather, a humanist goal: to give the four doctors a voice. "We wanted to shed light rather than heat over the issue," Wilson explains. "There were just so many questions that remained from hearing the story of Dr. Tiller's death that weren't really addressed in the news coverage. It was treating it in the same ideological terms that they always treat the abortion issue—a black-and-white debate, and [the] two camps on either side are very polarized. They weren't looking at the doctors or the patients involved as complex human beings."

What transpires is an intimate portrait of four exemplary physicians who soldier on in their profession despite increasing hostility, legal and logistical issues (such as having to open a new clinic out of state once late abortions are outlawed in their jurisdiction), and difficult personal choices—the wish to retire and not continue to expose their family to danger.

Late, or third-trimester, abortions (after 25 weeks), make up less than 1% of the total abortions in the US. A widespread misconception is that the women who request such abortions do so brazenly and carelessly, because they were too negligent to end their pregnancy earlier. But in fact, the truth could not be more different; the overwhelming majority of late abortions are sought for the most devastating medical reason: a fetal abnormality detected late in the pregnancy.

Many intimate vérité scenes of the film reveal the intense suffering of incredibly distraught patients, for whom this was a planned pregnancy. These unquestionably loving, caring and often deeply religious parents—who until recently were joyously expecting a healthy baby—are now in a desperate situation and racked with guilt by their decision.

As Martha Shane points out, "Audiences don't have any idea the percentage of these abortions that are wanted pregnancies. It's really a child to them already; they have been preparing for it. The patients give you a really good sense of how much they love this child already, even though it hasn't been born."

It is difficult to view such scenes and maintain a dry eye. Since a late abortion effectively entails the delivery of a stillborn, the mothers are saying hello and goodbye to their child at the same time, and the doctors and staff do their best-despite the tragic circumstances—to make this a precious experience for the parents, complying with requests to spend time with the fetus, for hand and footprints, and creating a memory box.

Obtaining patient participation in the film was quite an obstacle. "Initially we wanted to do portraits of the doctors," Shane explains, "but pretty quickly we realized that what motivates them to do the work are these patients and how they really are the most desperate. And we realized we needed to have patients in the film—at least their voices—in order to really have a full portrait of these doctors' lives. The most difficult part of making this film was not knowing necessarily if we would be able to find patients who were willing to be in the film."

Wilson adds, "Understandably, these people are going through some of the most challenging situations of their lives and the vast majority of the people did not want to participate in the film. So there was a lot of waiting around, hoping a patient would agree. We had the counselors bring it up in the initial session...Most people don't understand why you might seek a third-trimester abortion because the circumstances are unimaginable...The few patients that participated in the film got the value that this would bring to increasing compassion and understanding among a wider audience."

Throughout the filming at the clinics over the course of two years, the youthful filmmakers were often asked if this was a part of a school project. Indeed, Wilson and Shane feel that in addition to hiring female cinematographers (Hillary Spera and Emily Topper), their youth made them more approachable, particularly when the patients were facing the situation alone: "Martha and I, being 27-year-old women, helped too, because not only we were an unintimidating presence, but also we were the same age as a lot of the women who were there; we were women of a child-bearing age. Some women were there alone, and one said, 'It was so nice I had a couple of other friends around as I went through this.'"

The controversial subject matter made funding even more difficult than a typical documentary. Major documentary grant foundations were extremely wary and fearful of being involved with such a sensitive issue, and were concerned of the political repercussions of the film. "We would say that we are just going to take a very honest nuanced look at this," Wilson recalls. "And I think people understood that when they saw the final film."

Luckily, supporters like the Sundance Documentary Fund and Chicken & Egg Pictures understood their vision early on. "Chicken & Egg were great," Shane says. "They were one of our earliest supporters. They are a documentary fund; they fund films specifically by female directors, and social issue films. And they provide not just financial support but also a lot of mentoring. They helped us a lot on how to pitch the film to funders." The film also received support from IDA's Pare Lorentz Documentary Fund.

Given Dr. Tiller's murder and past attempts against the doctors, the filmmakers were justifiably concerned about the safety of their subjects and did not wish to expose them to even greater danger. Shane states, "From the very beginning we had conversations with them about security and they all came to the conclusion, on their own, that without telling their story there's sort of a vacuum and there's silence; it's so easy to vilify them in that situation. I feel that what our film does is humanize them and make them more relatable to people regardless of how you feel about the issue of abortion. We were careful not to show where they live and what car they drive, but for the most part we found that the anti-abortion people already know most of this information."

Security concerns were even extended to the festivals: At Sundance, where the film premiered, there were armed guards, metal detectors and bag checks at each screening. But in fact, reactions to the film were overwhelmingly positive. "We went to Sundance and we were concerned that there might be hostility; we were prepared for protests," Shane maintains. "And we were very grateful to the festival that they wanted to take all the precautions necessary. There is a history of violence in this country against abortion providers and clinics, and we wanted to make sure that the doctors and the audience members would feel comfortable. I hope that people were comforted by the fact that we were paying attention to security. The best part for us was seeing the doctors get all this positive attention and having people say how much they admire them and how grateful they are for the work they are doing. It was wonderful for us to see that. What they are more used to seeing are threats and harassment and more negative attention; with the film, they were getting more of the positive attention that they deserve."

Whatever one's personal views about abortion, After Tiller is a thought-provoking, challenging and sincere film that shatters preconceptions and provides novel perspective on a timeworn debate. It reveals four doctors who are acutely aware of the ethical and moral complexities they have to navigate on a daily basis.

 "There are also people who come in and don't change their mind, and feel just as strongly as before," Wilson observes. "But they always tell us that they felt it was fair, and that they were glad they saw it because they learned some things they did not know before. If people are thinking and talking about this issue in a calmer, less attack-oriented way, and it raises questions they had not thought about before, then that's a success for us."

After Tiller opens September 20 in New York, and October 4 in Los Angeles. The film is distributed by Oscilloscope Laboratories.

Darianna Cardilli is a Los Angeles-based documentary filmmaker and editor. She can be reached at www.darianna.com.